>>All right. Thanks, everyone, for coming. I know it is the end of the
semester, so it’s kind of a busy time, especially
on Friday afternoon. I only have probably about 45
minutes worth of slides to talk with you about so time for
discussion afterward is great. It would be wonderful to
get your feedback on the work I’m doing in this
area right now and before I get to that I will talk a bit about the
general research literature and what it says about parent involvement
and kind of parent influences on emotion regulation development
in children with ASD and my work that’s been more focused on the
typical or general population and how that led to my interest
in this area. And if my voice goes about
halfway through, I apologize. I have some sort of allergies
thing going on. When I ran this
last night I couldn’t talk by the end of this. I will apologize. I will drink my tea as necessary
as well. There we go. Advancing slides. We can handle it. Emotion regulation in the
literature, we tend to see somewhat different definitions. The one that I think is the best
and the one I tend to use is the Thompson & Goodvin definition
which says that emotion regulation is the ability to increase,
maintain or decrease emotional intensity according to
context. So how well the do you know how to
manage your emotional response given the situational demands,
cultural expectations, et cetera. When we talk about emotion
regulation it is one of many skills we talk about in the
constellation of self-regulation skills and we know more and
more in the research self-regulation is really
paramount to kids’ success in life in school, out of school. They need to learn to
be self-regulated. Emotion regulation as a piece
of that is essential to achieving social
competence and positive behavior in various situations. On the flip side, kids who
struggle with emotion regulation tend to have issues with conduct,
anxiety, depression, maladaptive behaviors down the road. So at the preschool stage, we see
kids going from rudimentary simple emotion regulation
techniques and developing more advanced, sophisticated
techniques and emotion regulation skills. A lot of that comes with the
social context of a preschool. So you might stay home with mom
or dad until 3 or 4 and then you have to go to this new
environment with other kids, learn how get along and learn
how to be successful. Preschoolers have to learn to
regulate their emotions in the context of other kids who also
have varying degrees of emotional capacity or regulatory capacity. The typically developing
literature basically says that kids do pick this up. They eventually learn how�–
what social rules are implicit in the situation, what emotions
are appropriate. You know, Johnny takes your toy. Eventually preschoolers learn
you don’t smack Johnny and start screaming. You say, �I want a turn,� or go
find your teacher and tell her what happened. Eventually preschoolers learn to
Exaggerate their emotions, suppress their emotions or
substitute or neutralize their emotions to achieve the social
goals that they have. When we look at kids with
autism, some reports estimate that up to 70% of children with
autism struggle with emotion regulation. That’s a major deficit or issue
for kids with ASD. A similar proportion of children
with ASD are estimated to be at risk for long-term psychiatric
disorders which to me is connected. We can see anxiety and
depression, underlying issues with emotion regulation can lead
to those issues. There is also research to say
emotion dysregulation is positively correlated with
all core symptoms of ASD. So the more severe we see
deficits in restricted and repetitive behaviors, social
communication, the more likely the child is going to
struggle with emotion dysregulation as well. So to kind of talk through the
differences that are evident in the literature now between
typically developing preschoolers and preschoolers
that have ASD, I just made a comparative chart essentially. Typically developing
Preschoolers, again, begin to internalize those self-regulation
skills. They begin to learn the situational
demands and what it means about how you should be expressing
emotion. Over time they exhibit more
sophisticated strategies like cognitive reappraisal. �I really want that toy and
I’m really mad that Sally won�t give me a turn, but
I�m just going to go And I�m just going to find
something else to play with for a few minutes until
she’ll give me a turn.� They might think about how do I
change my feelings about the situation to help regulate my
emotion. They might engage in mental
distraction. �I really miss mommy and I want
her to come pick me up, but I�m going to go
play with my truck so I don’t have to think about mommy.�
So whether or not that’s actually conscious in what
they are doing they develop the ability to be more regulated on
their own. We look at observational
research coming out focused on preschoolers with ASD,
we see those kids struggling with these skills. They have less capacity to
regulate their own emotions. They seek out the regulation
from their parents, but they don’t necessarily have that
ability to internalize the skills as much as typically
developing preschoolers. Over time they use more simple
strategies like vocalizing negative emotion, avoiding
situations that are emotionally provoking, engaging in
repetitive or idiosyncratic behaviors that are
characteristic of autism in the face of frustration. They also tend to be more
resigned and we see higher levels of negativity being expressed
among children with ASD when they are put through various lab
paradigms meant to elicit frustration. So my interest in how we go
about intervening or addressing emotion regulation comes from
how can we change parents. How can we prepare parents to
support the skill? So this interest, I think,
has evolved over time beginning with my dissertation
work. I was interested in parents and
how they impact emotional relations. This chart is focused on the
typically developing population but talks about how the parent
role in emotion regulation, development evolves over time. So parent holds the infant, the
infant is crying, they soothe the child through verbal or
physical comfort. As children age into toddlerhood
parents tend to use more language-mediated interventions
to support emotion regulation. They might say “use your words”
when the child is upset or �use your belly breathing.�
My son — I love the Elmo belly breathing video. Take deep breaths to calm down. Elmo had this cute little song. There�s cute little ways
that parents tend to support toddler emotional
regulation and, of course, ignoring inappropriate displays. Teaching them it’s not okay to
have a big temper tantrum in the restaurant, and trying your best
to just ignore it. As children age into the
preschool period, parents continue to use that kind of
language-mediated interaction to support emotion regulation. They might engage in game-like
interactions. �I don’t see you smiling. Don’t you smile right now. I don’t want you to smile,� and
then all of the sudden they are laughing instead of crying. This is very present in my life
right now. The examples are pretty easy. Diverting attention, refocusing
children if they are upset about something, trying to get them to
think about something else and the last two points are really
important. Modeling your own appropriate
emotion regulation. Not being too negative or
hostile in the face of emotion and also not kind of
disregarding emotional displays, also acknowledging that emotional
displays are appropriate at times. So my dissertation work got me
started in this area. I looked at the interactions
between various parent-child interactions and child
characteristics of how those impacted social competence at
school entry. So the data I used is
from the early childhood longitudinal study
birth cohort or the ECLS-B which is a longitudinal
study of children born in the United States in 2001, and they
used about 7,000 dyads from the study that were studied over the
infant two-year preschool and kindergarten time points. We looked at various measures
of parent responsiveness, emotional support,
attachment, child negativity, and the outcome I was interested
in was parent report of children’s social competence
when they reached kindergarten age. They were 5 years of age. I’m not going into much detail
with the study. This is the final model that was
tested and I highlighted the paths in blue I found to be most
interesting and that I think continued my interest in emotion
regulation. We found that at 2 years of age how
negative the child was correlated to how negative the
parent was. There was a bidirectional
relationship there. And that degree of negativity
the parent exhibited at 2 years was related to how negative the
child continued to be in preschool. We saw long-term effects there. At the preschool age how
negative the child related to what degree of emotional
support the parent was providing in a negative direction. Parents providing less emotional
support to children who were more negative.>>I’m sorry. You might have said this and I
might have zoned out for a minute. What measures were these?>>They are observational up to
the kindergarten time point. The social competence measure
at the end was based on parent report. The rest came from observation.>>These are parent-child
interactions.>>Yes. They were ten-minute
interactions, yep. Playing with two bags of toys. And then the degree to which the
child was negative related to their social competence in
kindergarten. They�re more negative, they had
lower social competence. And what degree the parent
supported their emotion in preschool related positively to
their competence at kindergarten age.>>I’m sorry.>>Sure thing. Yes?>>How is it rated in terms
of�– [ Inaudible ]
>>The negativity?>>Mm-hmm.>>So I have the�– I think in a
later slide I have the operational definitions. Basically they gave the parent
two bags of toys to play with for the child. They said go ahead,
start with bag one, play with it until the child is
ready to move on and then bag number two. Child negativity was any sort of
negativity expressed toward the parent like anger, hostility. And same way for the parent. Any disdain, anger that the
parent expressed toward the child.>>Demonstrated by�–
>>It was coded by trained coders. They hired trained coders as
part of the study. They trained them up and they had to
maintain 85% reliability over time. They monitored that.>>Thank you.>>Sure.>>On my post doc we did another
study with the data and looked at whether these similar
relationships between parenting practices and kindergarten
social behavioral skills would be moderated by region. So whether you were from a rural
area, suburban or urban area and whether that moderated these
relationships. So, again, ECSL-B data,
we had a sample of about 6,500 parents and children and we
found parent emotion support when children were in preschool
and they have the operational definition there. To what degree the parent
displayed openness to emotion, how much physical and effective
support they provided to the child was related to the
child’s kindergarten social skills via parent report. We did find that rural status
partially mediated effects. We found kids from rural towns
had lower social competence skills partially because parents
at the preschool age provided lower levels of emotional
support. That was the only difference
we found though. In other areas it was similar. For this study we looked at some
of the negative parenting behaviors as well. We found when parents were more
Intrusive � so if they were more controlling, denied the child’s
perspective during the interaction children tended to
have more externalizing behaviors at the kindergarten
time point. And that was for both parent and
teacher report of the externalizing behaviors. We also found how negative the
parent was and if they were rated as being detached, or
kind of lacking awareness or engagement at that
preschool age those were related to teacher report of
externalizing behavior at the kindergarten time point for the
children as well. So in general before moving on
to the ASD position�– population and specifically,
what this previous work, you know, said to me was what
parents do in the preschool age is important. We need to be able to prepare
parents. We tend to focus a lot on
academic support and how to get kids school ready. We don’t talk as much about
emotional support. Over time I think that’s gotten
much better, but it still deserves, you know, a lot
of attention and how to intervene with parents at the
younger ages. So specifically in the ASD
population, obviously parents have additional challenges. They’ve got to work through the
complex presentation, social communication deficits,
restricted and repetitive behaviors, language delay in
some cases and still try to address emotion functioning in
their children. What the research coming out and
is really in the past I would say three to five years saying
is that parents do make efforts to support emotion regulation in
kids with autism but they need to be very flexible. They need to know when to use a
simple and when to use a complex strategy. When will this work with my
child given their unique needs. We know based on previous
observational research when we look at the toddler age what
parents do to support emotion regulation is kind of similar
across typically developing and toddlers with ASD. Typically developing parents
evolve. They get more complex in how
they are prompting that. Parents of children with
ASD�tend to remain simple in the way they are attempting to
support emotion regulation likely because the child is
struggling to gain those skills at the same time. There is research to suggest
that parent affect impacts emotion regulation development
in children with autism. Some really interesting�work that�s
coming out is saying when you look at parents — and the study I
have up here by Bader, Barry & Hann had parents report
on how negative they are toward their child. How much criticism or hostility
do they display or levels of emotional involvement. They found it accounted for a
significant portion of variance in the child’s
externalizing behaviors. Specifically the criticism or
hostility piece was the most important that had a
positive effect on externalizing problems. Knowing parents of children with
ASD are at higher risk for having depression, negativity, hostile
kind of behaviors, given the challenges of raising a child
with autism, that says to me it’s important that parents know not
only what they are doing to support emotion and also how
their affect is being displayed and how they are responding to
frustration is important to be able to support the emotion
regulation development in their children. So in February I presented the
results of a study that I conducted to look at some of the
variables specifically in the ASD and developmentally delayed
population. I looked again — used the ECLS-B
data and I looked at the unique and interactive effects of preschool
child negativity and parent practices on social learning and
behavioral skills in children. These were the three research
questions I looked at. Basically I was looking at the
unique effects of child negativity in preschool on
children�s social and behavioral skills at age 5 and parenting
behaviors, their unique effects on children’s social and
behavioral functioning. I looked at parent emotion
support, parent intrusiveness, and parent negatively. And then I looked at whether
those � that child negativity and parenting behavior interacted to
predict social and behavioral functioning at age 5. These children are from the
ECLS-B identified with autism or another developmental disability at
the preschool time point. There are about 450 children,
predominantly male, predominantly white, and they
were about 4 years old at that preschool time point. [�Inaudible question�]
>>The ECLS�– that’s the early childhood longitudal study
birth cohort where the data is from the studies I
have been talking about. It’s a nationally represented
data set of children born in 2001. Again this was the observational
task I was talking about before. The parent was asked to play
with the child during a ten-minute observation with two
bags of toys. The predictors that I looked at
in this study are defined here. Parent intrusiveness, what
degree the parent was engaging in very adult-centered
directed behavior and kind of disregarding the child’s
autonomy. Parent negative regard. This is anger, disapproval or
discontent expressed toward the child. Parent’s emotional support, to
what degree the parent provided a secure base. Did the child seek support from
the parent? Did they appear they felt
comfortable looking to the parent for support? And to what degree
was the parent showing support and enthusiasm for the
child�s emotions. And then child negativity
was anger, hostility or dislike expressed toward the parent. The outcome variables I was
interested in came from the five-year child assessment. I referred to that before as the
kindergarten assessment. All the children didn’t
necessarily go into kindergarten at this assessment point. They were 5 years of age on
average. Parents were asked to report on
the child’s behavioral and social skills on a 1 to 5 scale. I did run the factor analysis on
these items because they kind of just mish-mash pulled from
different assessments and put them all together and these
were social behavioral items. Running the factor analysis
suggested there was a two-factor solution. Some of the items measured
social and learning skills. Does the child volunteer to help
others, are they well liked by peers? Do they keep working until
finished? And the other factor measured
externalizing issues like do they have temper tantrums, are
they aggressive, are they overly active. I recoded that scale so a higher
number was indicative of fewer externalizing issues. What I found looking at basic
correlations between the predictor variables is child
negativity at the preschool age was related to all three of the
parenting behaviors I was interested in. In terms of predicting
externalizing issues I found that when I entered controls, I
controlled for the age that the child was at the preschool and
kindergarten assessment, SES, race, and mental age at age 2. Those controls in combination
with child negativity and parenting behaviors explained
25% of the variance in externalizing issues at kindergarten age. Greater parent support for
emotion in preschool was associated with poorer behaviors
at 5 years of age. That was kind of an interesting
outcome. Counterintuitive. We would expect if parents were
doing a better job supporting emotions in their children in
preschool the child would have fewer behavioral issues at 5
years of age. I also found there was an
interaction of child negativity and parent emotion support and
predicting externalizing issues. So this is the interaction
effect. We found that children were
actually more negative in their preschool years — if they were
more negative in preschool and their parent provided more
emotional support they had more behavioral concerns when they
reached kindergarten age. What this says to me � it is
Counterintuitive, but it suggests perhaps parents are perceptive
to the fact that the child is being more negative at
the preschool age. They are trying harder to
compensate for the difficulties the child is having � they�re
trying to support emotions, but what they are doing is not
enough or not working to reduce externalizing behaviors later on
in life.>>Could it also be too
intrusive?>>That’s possible. Intrusiveness did not have any
positive relations to any of the outcomes. It is possible, I think that
what they are doing just isn’t working. It isn’t matching the child’s
needs or they need kind of a more complex level of emotional
support than what we see in the general population and their
ability to support emotion. But, yeah, that would certainly
make sense. It’s surprising the intrusiveness
didn’t have any relation to these outcomes.>>That was within the dyad
observation. Also wondering — I don’t know how
you would measure this. I wonder if kids that have more
disruptive behavior their parents are really nervous about
the�– and if that might be some of the parents doing a lot of
emotional support of kids who are highly reactive. Also I�– just clinically you
see the parents who are, oh, my gosh. Don’t lose it. I wonder if there are any other
types of measures outside of the interaction that might
explain�– might be child behaviors driving some of the
parent emotional support�–>>Mm-hmm. Yeah. I agree. I have to take a double look at
the data. I don’t think they did a very
good job of doing other measures. Oh, we have this observation and
outcome and we’re good. I agree. I think it kind of suggests
almost a reciprocal relationship between — I know
you’re negative. I will try to do what I can to
support it and not necessarily changing anything long term but
I’m providing more support at this time to try to compensate.>>I find parents of kids
that are highly reactive structure their interactions to
avoid those reactivities.>>To try to not —
>>So they don’t challenge them ever which in the moment keeps
things together, but over time doesn’t help kids develop the
skills they need.>>Yeah. That makes sense. Teach a man to fish. It’s not getting that piece. [ Inaudible ]
>>�– doesn’t really affect their skills�–
>>Mm-hmm.>>Doesn’t really impact the
skills�– parent emotions.>>Mm-hmm. Yeah. If the parents aren’t providing
support but the child is negative we aren’t seeing the
interaction to impact, yeah, long term externalizing. That was interesting to me as
well. Mm-hmm. So the other outcome I was
interested in was that social learning behaviors outcome. I didn’t find any support for
positive effects of child or parent behaviors on that
long-term outcome. Together the controls and the
child and parenting behaviors predicted 16% of the variance,
but there were no significant� beta weights. So I think logically and there is
some research to suggest that emotion regulation impacts
social competence, but then again in the way it was measured in
the study it doesn’t seem to have much impact on those
behaviors. So to kind of bring this all
together, what the current literature says in terms of
understanding emotion regulation in children with autism, we know
they commonly struggle with emotion or dysregulation. They tend to engage in simple efforts
to try to manage their own emotion. We see differences beginning in
the preschool and toddler period between typically developing
children and children with autism. We believe emotion dysregulation
is linked to long-term social competence and behavioral
issues. Parents of children with ASD, we
know they support emotions or try to support emotional
development. They may not be doing enough to
support long-term outcomes. The research also suggests that
parents need to have this idea that they need to be flexible. They need to be aware of their
child’s needs and when and what type of supports will work to
support emotion regulation. Parents also need to be aware
of the fact that their own affect can impact their child�s
emotion regulation activities. If they are hostile or critical
they may be exacerbating the dysregulation or those
behavioral issues in their children. So the intervention world has
not really addressed the skill in young children with autism
yet. The interventions that have been
created to address emotion regulation in children with ASD
target older children beginning about age six and older. I would say most of the programs
are targeted towards the adolescent or at least older child
population. There’s been some cognitive
behavioral work that’s got some good research behind it to
support emotional regulation in older children. As a proponent of early
intervention, I always like to think about how we can intervene
even earlier. I think we have enough
evidence in the literature to suggest that we
can change parent behaviors to support emotion regulation in
children starting at the preschool age. We know based on some
observational work that mothers tend to be a bit more effective
than fathers in supporting emotion regulation in children. That’s one study and more work
needs to be done. It’s why I have chosen to focus
on mothers to begin with in terms of intervention work. We know parent-mediated
interventions in general are indicated to treat all of the
core symptoms of ASD. We have been very successful and
effective in treating behavioral, social skill,
and communication in kids with ASD. So the intervention that I’m
developing is called regulation of emotion lability in autism
through caregiver supports. It took me a long time to think
of that acronym, so I’m pretty happy about it. I had to think of something that
would make sense to use as an acronym. So it was exciting. So this is a�– will be a parent-
mediated intervention to address emotion regulation in kids
beginning at age 3 and going up to about age 6. I have been funded through the
organization for autism research to run a pilot study on this
intervention so I’m really excited to be doing this work. What the RELACS program will
look like is eight weekly sessions that will last between
an hour and an hour and a half. Each session will have a predictable
schedule so the interventionist will review the previous work
from the previous session. There will be a parent-child
observation. That will be part of data
collection to look at how the parents are using these
strategies. Then the interventionist will
provide instruction around the topic of the day. They will do a demonstration
where they�re demonstrating the skills they have been
talking to the parent about that day. And then they will engage the
parent in practicing those skills with direct feedback and
coaching. They will wrap up the session by
talking about suggestions for how the parent can continue to
use the skills over the course of the week and beyond. And then the parent and
interventionist will work together to plan for how the
parent intends on using those skills in everyday interactions. So each session will have some
degree of modeling. The interventionist will
construct scenarios because the idea is the parents seeing the
opportunity to support emotion regulation, we have to elicit
some distress in the children. There will be different
scenarios set up to elicit mild distress because the IRB won’t
let me do anything else. Mild distress is what we are
going for which is good and model those interventions for
the parents and engage the parent in kind of practicing
those as well giving the parent in vivo feedback. Then the parent will be given
homework which is the practicing of the skills over the course
of the week in between each session. So these are the session topics
that will be part of each week. It will start out by teaching
the parent generally how to be an interactive play partner. How do you engage your child in
high quality interactive play? If the parent doesn�t know that,
they really won�t be able to use any of the other strategies. It’s kind of a way to build
rapport and ensure that parents know how to be interactive and
play with their children. Parents will be taught how to
identify children�s emotions doing things like
labeling, engaging the child in emotion-focused games,
matching, emotion identification. Parents will then be taught how
to model and use effective emotion regulation so that they
are aware of the fact that being overly negative or engaging in
this behavior themselves impacts what their child knows about how
to regulate emotions. They will be taught how to
use strategies to help children regulate their
emotions. Some of the literature says
parents tend to be simplistic in supporting emotion regulation in
children with ASD so we�ll focus on what are the more complex
strategies, when might it be appropriate to use more complex
strategies like cognitive reappraisal if the child
has the capacity to engage in that sort of
regulation. Then we’ll introduce different
tools that the parent might use such as an anger thermometer
like a Tucker turtle to engage the child in fun ways of
practicing emotion regulation. Then the last three weeks focus
more on long-term how parents can collect ABC � antecedent
behavioral consequence � data, understand
what is behavioral data, how does that help us match
interventions to our child’s needs. So they will be asked to collect
data on their own and we’ll talk about how they can use date that to
identify why dysregulation is happening and match the function
of the behavior to what type of strategies might
be appropriate in different situations. And the last week we’ll talk
about how to generalize strategies, how to use these
strategies even after the intervention is over. So I�ll be recruiting — I’m
starting to recruit parents of children with ASD who are
between the ages of 3 to 6 years with a medical
diagnosis of ASD. I’m looking for children who are
higher functioning. They need to have an IQ of at
least 70 and either a verbal or nonverbal IQ of at least 80. I am also looking for children
who can score at least 80 on an expressive or receptive language
scale. The idea is at least when
piloting the intervention I am trying to limit it to children
we can assume their dysregulation is due to actual
dysregulation and not, for example, a child who has very little
language and they might be dysregulated because they
have no language to express their needs. I will be looking for children
who are reported by their parents to engage in
dysregulated behavior at least four times a week and mothers
who are fluent in English. The design will be a multiple
probe design with staggered introduction across dyads. So parents will be randomly
assigned to one of various baseline phases and complete the
eight-week intervention phase and a three-month one-time
follow-up. So I have very lofty goals of
coding for many, many parent and child behaviors to analyze the
effects of the intervention. We’ll be coding for the parents’
efforts to support emotion regulation. The various ways, strategies
they will be taught in terms of how to�support emotion regulation
in their child � things like mutual engagement, providing
verbal comfort, encouraging, directing, distracting,
redirecting, acknowledging emotions. We’ll be coding the child’s
regulatory abilities. So can they distract themselves,
do they engage in self-talk. And more simplistic and
sometimes negative behaviors like crying and yelling,
refusing. We’ll also be coding their
distress, so we�ll be coding the frequency with
which they exhibit distress during interactions with their
parents and the intensity of that distress. I will also be administering the
temperament and atypical behavior scales to parents at
pre, post and three-month follow-up, just descriptive data,
to corroborate the findings of the observational data, and the
parents will be administered the behavior intervention rating
scale at the end to gauge acceptability. This is just an overview of the
analysis. I will be using visual analysis,
the TauU summary index, and PAND to evaluate intervention
effects of the observational data. And then I�ll look at the
reliable change index of the TABS pre, post, and three-month
follow-up scores and then just descriptively on the BIRS scores
to evaluate acceptability. Okay. That’s everything. I think that’s probably the end
of my voice, too. Worked out pretty well. I welcome feedback. I’m starting recruitment now. I know that’s probably going to
be a challenge. But anything else, any other
Thoughts anyone has?>>I’m wondering if you are
thinking of having the parents keep a diary. If it is all observation-based
it will depend on the toys in the session.>>Yeah.>>The kids that come in. I imagine you will have a lot of
variability especially because the kids are variable. I wonder if you can get
caregiver diaries for better data about behavior across the
day. I can imagine a situation where
you might have an effective intervention where you are not
picking it up in the observation.>>That’s a good idea. I have worried about that
because we have to elicit possible distress to code.>>I’m worried there because you
might see parents not eliciting it because if the goal is to
have your child be regulated.>>Mm-hmm.>>I think it’s an awesome
measure, but is there something else you can do?>>Yeah. That’s a good idea. I will definitely think about
that. You certainly don’t want to run
a whole intervention and not have any data to suggest it’s
effective.>>It may very well come up. I’m just imagining sort of the
amount of variability you could get.>>Yeah.>>With observation.>>I have thought about that. My plan is to build in tasks
that in the past in kind of this observational work have
elicited distress, but it is the idea
of�– it’s just ten minutes. You never know what you will
get.>>I can imagine it would be
helpful for coding like are the parent behaviors changing.>>Yeah.>>It’s more like are they going
To –>>Mm-hmm.>>What if the parents are doing
a great job but the kids had a bad day?>>Yeah.>>Or other�–
>>Mm-hmm. Yeah. That’s good.>>If you’re doing ABCs, you are
going to have the parents do ABC tracking anyway. I wonder if you could have it be
something you do as a baseline.>>Oh yeah. Good idea.>>And track it.>>Mm-hmm. Yeah. They could track the outbursts
and have that data. That would be neat. That’s a good idea.>>Even just tracking�– you can
train them to track behavior prior to treatment and don’t
track the ABCs � or the As and the Cs, just the Bs.>>That would be a lot to do
ABC.>>And treatment of the ABC they
are already tracking.>>Mm-hmm. [ Inaudible ]
>>Good idea.>>I’m all about trying to
figure out ways of getting outside session data. I have been thinking about this
a lot in our own stuff which is how do we get sort of more
ecologically valid measures and what’s going on in the home
environment.>>Yeah. Stuff that parents will fill
out, too. That they won’t forget it or
it’s not too daunting.>>Sampling? Have you thought of that?>>I have not.>>That might be another thing
if you can text them.>>That’s a good idea.>>We haven’t done this either
in our work. I have been really trying to
think about how we do this more and particularly with something
like�– we have been struggling a lot with this in our social
data because language is something you can really elicit
easily in a ten-minute sample.>>Yeah.>>You can see if kids use
language and set up reliable situations to get parents to
elicit it. But what we are finding is for
social engagement, whatever ways we are setting it up, there is
so much variability depending on the things in the session like
the toys and things going on that we are not reliably getting
which could mean we are not changing social behavior. But parents, when we ask them
what do you feel changed in the intervention, more than
language, more than things we get actual visual changes on are
social. My kid wants to play with me more. We are not capturing it in these
ten-minute parent-child interactions.>>Mm-hmm.>>This is why we are thinking
about this.>>Yeah.>>You were hypothesizing what
it is that’s like, you know, highly salient low frequency
behaviors that parents are judging this on.>>Yeah.>>That aren’t going to come up
in a ten-minute observation.>>Mm-hmm.>>Same thing with
self-regulation. He might, she might have no
major problems in session but has an enormous tantrum at home. That’s extremely problematic
with the family. It may or may not come up in
session.>>Mm-hmm.>>I�ve been throwing around
those ideas like how do we�–>>Yeah. That’s so true. Or it could be just when they
are out in the community that this stuff happens.>>Yeah.>>It’s changing but we are not
catching it. Mm-hmm.>>Also a daily diary where you
say at home how many of these events happened. School, shopping.>>That’s a good idea.>>I’m curious. Brooke, you mentioned using
momentary time sampling with parents by texting them
periodically. Can you hear me? I’m sorry.>>We’re cranking you up, Marty.>>Okay. I’m curious about Brooke’s idea
about the momentary time sampling with the texting. Can you elaborate on that a
Little bit? I’m curious on how that would
work.>>Basically you could do�� I
Haven�t done it in my work, but a lot of people do it in social
psych. You have a brief survey hooked
up and you get buzzed. You do it randomly throughout
the day. You have the parent stop and
report. It could be things like how
regulated is your child right now? Three or four times during the
day. It only takes a minute to
respond. It’s on the phone. People do it for emotion
reporting for their own personal emotions
People do it around trying to measure sort of personal�–
self-affect. I’m wondering if you can make
that for the child as well. Might also get a parent affect
as well if there is parent negativity.>>Right. It’s a very interesting idea.>>But then the random moments
still may not capture the big outbursts so the end of the day
reflection would maybe elicit it in a way.>>That’s true.>>Connie, what were you going
to say?>>Are you also capturing from
teachers or schools?>>I hadn’t planned on that. But it’s a worthy avenue, I
think. It is always nice to have
multiple opinions, too. Multiple informants. Yeah. I wonder if I could get teachers
to do that at least weekly or something.>>Sometimes my�– I’m just
thinking about maybe there is some defect the parent thinks he
or she is already attending the intervention, doing better.>>Yeah.>>So it could be different from
an outsider looking at things.>>Yeah. That’s true.>>Where would you be doing
this?>>So it will be in the parent’s
home.>>Oh, okay.>>We’ll go to their homes and
work with them there. Mm-hmm.>>And�–
[ Inaudible ]>>Mm-hmm.>>So many�–
>>Standards for single case design is basically where I
started from. So the latest is you need at
least four to five data points per phase. Starting with the five-point
baseline and then moving up. It gets really big really fast. That’s one thing I’m not
really�– I thought about breaking it into 3 and
4-year-olds and 5 and 6-year-olds and running two
groups and then I could have shorter baseline phases and
I could look at differences between age groups
and treatment response. I don’t know. It is a really long baseline
phase for the 13-weekers. That’s why I did the multiple
probes so we don’t have to do every week. But still, it�s hard to keep them �
I would worry about losing them, too. That’s long.>>And you mentioned they have
to have mild stress. How do you define mild?>>Good question. In terms of eligibility, the
only thing I would ever�– I plan on kind of saying, you
can�t be a part of this would be if they engage in
extreme self-injury. That would be something I
wouldn’t expect this intervention is going to do and
we wouldn’t want to elicit distress in a child who is
potentially hurting themselves over and over again. Between mild and moderate. It’s hard. I haven’t necessarily
operationalized it yet. But whining, crying, throw
yourself on the floor, kicking screaming tantrum.>>Would you also consider the
stress level of the parents? I can see if the parents are
really stressed out versus some other, they have a lot of
support. They could be reacting
differently in these types of interventions. Even the compliance of
responding to your diary or assessment.>>Mm-hmm. That’s a good point. So do you think that would be
worthy to think about in terms of eligibility criteria?>>Some baseline control.>>Yeah, just to know.>>Yeah, I think absolutely
having four parent measures in there would be great.>>Okay.>>Just in general. Not necessarily as screeners,
but�–>>Just to know, yeah. I thought about the parent sense
of confidence scale and possibly the parent motivation index. Parent stress makes sense, too. This is something you would
expect stress to be related to. [ Inaudible ]
>>Oh, yeah.>>There is also good measures
about mom’s emotional expressiveness. I have quite a few of those if
you’re interested.>>Okay. Yeah. That would be great.>>So I’m really curious sort of
how you envision�– I mean, I think of it as two separate
literatures. I’m thinking how putting it
together that envision these sort of emotion regulation
strategies that the parents do and how they sort of fit into
sort of broader behavior management literatures or PBS or
something like that where there is a lot of direct training on
changing the consequences and�– control. If you are tracking the ABCs I
assume you are putting these together. I’m curious in terms of how you
see them together, separate, both. What would be one versus the
other?>>Mm-hmm. Yeah. I think it’s kind of something I
expect to figure out in this pilot. I felt like if we just give them
the strategies and leave them it doesn’t really help them
problem-solve in the future. This idea that, you know, kids’
emotion regulation might get better but there might be things
in the future that’s going to dysregulate them. Helping parents understand how
to make meaning out of that like why is this
dysregulation happening would be the idea of building in
some of that ABC, you know, behavioral management stuff. You know, I think it’s separate
but related, I guess, is that there are behaviors that happen
strictly because they are behaviors and they are being
managed by the environment, the antecedents and consequences are
the reasons for which they are happening, but with emotion
dysregulation, the function could be just kind of
temperamental dysregulation as well. There might be a function that’s
not kind of the typical behavioral function that we are
talking about. Yeah. So I foresee some potential
challenges there in terms of the utility of teaching that ABC and
behavioral management stuff and then saying, well, okay,
we want to think and problem solve in the future. How do you match this to the
strategies that might work.>>It was a bad�– from a
clinical perspective I think it all makes sense. I’m just thinking when we are
doing this we often start with this behavioral strategies and
also we need to get the child’s skills.>>Yeah.>>Changing up the
environmental�– for the child skills to be able to regulate in
situations when you’re upset. But then I was thinking — trying
to put it all together from like a parent perspective, a lot of
the strategies you might use to help a child regulate such as
verbal mediated, you’re angry, I can tell you’re angry. Think
about –>>Mm-hmm.
>>– might actually be in contrast with some of the
behavioral contingencies that may be maintaining it. For example, the attention. I’m not necessarily saying the
behavior�[ inaudible ] at all. I’m just�– this is getting me
interested thinking about it from a clinical perspective
and theoretically you might find if behavior is maintained and
the parent is taught to use strategies such as, I can see
you’re really angry, let’s do this.>>Yeah.>>I was wondering sort of is
that somewhere that you�re just going to say, I’m not
thinking from a function-based perspective. We�re really just working on
self-regulation, we�re going to be teaching self-regulation or
are you thinking about integrating the two and how do
you put those pieces together?>>Mm-hmm. I think about integrating
the two. Ideally what I would like to do
is get a parent to the point where they can recognize that. That strategy doesn’t work
because the function is attention. If you are labeling emotion you
are giving the attention the child is seeking. Whether or not that’s an
achievable goal is the question. But that would be my ideal. There are strategies but the
parent knows kind of in a more meaningful way how to use them
because they are able to identify the function of
behavior and say, okay, this is why this is happening or maybe
this child is dysregulated because they are dysregulated
and I can use the strategy and I’m not going to worry about it
perpetuating the behavior essentially. So, yeah. Yeah. That’s kind of how I think about
it.>>Cool.>>What about — siblings are an
important part of teaching social skills?>>Mm-hmm.>>Also you are using a lot of
modeling here. Are siblings modeling emotion
regulation in a way that’s meaningful for kids that they
are learning from as well? Are you looking at siblings,
eliminating siblings?>>I don’t plan on incorporating
them in the pilot. I think it’s something that’s
important to think about down the road.>>– families that have another
sibling to consider that?>>Yeah. Oh, absolutely.>>If they have a sibling
that’s older that might be a good source of modeling.>>Yeah. At least to know and talk about
potential threats to the intervention.>>I don’t know how you handle
covariates with single case design.>>Yeah.>>Maybe just make sure families
don’t have siblings, I don’t know.>>Yeah. I can see especially if there is
a sibling that was on the spectrum or had some degree
of�– and disorder that might be a concern for sure. Potential other dysregulation
being modeled in the family. Yeah.>>If they don’t have ASD that’s
helpful.>>Yeah.>>Maybe not completely�–
>>Oh, yeah. They could be taught for sure.>>Yeah.>>Mm-hmm.>>I’m also really curious�–
just — this is more from a clinical perspective. In terms of the strategies you
are teaching the parents, clearly going for high
functioning kids. In terms of the strategies
you�re teaching parents, do you have a slide of what
those are? I think you mentioned�–
>>I have the codes based.>>Mutual engagement, vocal
prompting, questions. So, you know, what’s the problem
kind of thing? Physical comfort, verbal
comfort, encouragement, redirection, visual supports,
those things. Acknowledging emotions, ignoring
distress. I’m wondering since a lot of the
stuff we do with older kids, just clinically, is things like
actually teaching the child self-calming strategies, deep
breathing, five and five, stop, think and blah, blah, blah. I know you’re working with a
younger group. We usually do that in
combination with sort of the thermometer or the visuals. So if they are doing the
visuals, teaching them to use visual supports are they also
encouraging them to use sort of physical calming things? And I’m just curious which ones
you are thinking of in that age range. Usually we have done this mostly
because it�s school-age kids who come in for clinical
treatment. And I’m really curious as to
like which ones would be good for this age range, and do you
think kids that age can learn it? I think that would be real�–
that’s such an important ability to actually down regulate,
decrease physical arousal.>>Mm-hmm.>>That’s a really important
piece of this.>>Mm-hmm.>>My thought is it’s going to
be heavier on the parent side of what the parent is doing to
prompt it than what the kid is doing on their own. I think kids can be taught like
the Tucker turtle thing.>>What�s —
>>You tuck in like a turtle and pretend you’re a turtle and stop
and think before you react.>>Yeah.>>That’s something that�s
been successful in the typically developing preschool
population �>>And that�s in that age range.>>Yep. I would love to incorporate that
here and teach parents how to prompt that. Kids think it’s fun.>>A hug.>>Yeah, basically. It’s like the deep breathing
thing.>>Does that work with preschool
age kids?>>Clinically, yes, I think it
does. I don�t —
>>I have never done it with kids under 5. I don’t have any idea. With my own kids, uhh.>>Personal experience. Yeah. So I think that’s a piece that
I’m still getting together. What are the specific things
that we�ll be expecting kids to do on their own. I think there are — to some
degree it’s more going to be the parent, you know,
what the parent is doing. And part of the strategy is that
the parent is going to be taught is not just kind of the action
of what they can do to prompt the regulation, but also
environmental strategies. How do you change the environment? If there is something
distressing that, continues to be distressing, how might you
change the world.>>The As.>>Yeah, the As.>>Again, this is just clinic�–
I think this is such an interesting topic. I get very excited about it. I’m thinking about it from a
clinical perspective because this is such an issue for these
kids.>>Yeah.>>I’m also curious about
something like video modeling in terms
of�–>>Mm-hmm.>>I know this is a parent-
mediated intervention, but teaching parents to use video
modeling around the strategies for kids. Just because I know we have
things — there is something called Go Noodle on YouTube. It’s free. They do it in my daughter’s
kindergarten class. They do all sorts of deep
breathing and there are yoga moves in it. I haven�t actually seen it. She loves it. They’re doing it in kindergarten
like sort of self-regulation.>>Yeah.>>I was thinking that might be
something in terms of parent- mediated things that they can
do. For design purposes you don’t
want to go there because it might be introducing too many
different pieces.>>Yeah.>>Just thinking about how would
you develop this type of intervention beyond just the
research end. I’m also curious about some of
the potential video models for those kids.>>I think it would be a good
thing to explore. Especially when you think about
engaging them in the intervention. You’ve got something that’s on
the iPad.>>Yeah. I’m not trying to make it more
complex.>>No, no.>>I’m actually surprised you
said 70%�– self-regulation issues�–
[ Inaudible ]>>Yeah. I can’t remember if that was
necessarily a representative�– that study may not have been
completely representative.>>Or what the cut level is
to say �problem.�>>Exactly. Yeah.>>When are you planning on
recruiting families?>>Now. Starting within the next few
weeks, I will be doing eligibility assessments.>>I will talk to Nicky
and see if we have any kids that have finished that are in that
high functioning range. We have had only one or two kids
that are that high functioning.>>Okay.>>One of them we literally just
enrolled. So that will be nine months, but
the family is super motivated. And he’s exactly in this age
range. I don’t know what his
difficulties in self-regulation are, but he’s certainly a high
functioning 4�1/2-year-old.>>Okay.>>The family is really
motivated. He would be great. I will check with Nicky about
other kids that are high functioning that finished up. If we do I’m absolutely happy
to, like, pull them, send an e-mail. If you want to send them like
a little draft of what it is.>>Sure. That would be great. Thank you. We will do that.>>How are you looking for these
subjects?>>Planning to be in touch with
schools, preschools, surveying kids with — potentially with ASD
and also community contacts that have relationships with families
and who may be interested in being part of this.>>Five or six families?>>Five is what I’m ideally
looking for, yeah. Mm-hmm. I would love to recruit more
than that. Somebody will not qualify.>>Are you looking�–
[ Inaudible ]>>I wasn’t planning on it for
this city just because they have been�– it was really difficult
for another study.>>I would mention the kids may
not be as high functioning.>>I don�t think so. I kind of think they are
usually language-delayed. [ Inaudible ]
>>It’s mostly around the, kind of, what we can attribute to
actual dysregulation versus the child who is dysregulated
because they have low language skills or the cognitive
functioning. I wouldn’t expect them to
necessarily benefit from some of these strategies if they
were that much lower functioning.>>So you said it’s verbal and
nonverbal.>>Mm-hmm.>>And sometimes ASD families
have difficulty with verbal/nonverbal. I see your conceptual score is
70.>>Mm-hmm.>>I wondered would that be
difficult to record a child with ASD that has higher
verbal/nonverbal score? Do you know what I’m asking?>>Oh, yeah. They can have a higher�– it
would be okay�– conceptual is overall. If they had an overall score
higher than 70, that’s all right. Is that what you’re saying?>>I think what she’s getting at
is you could have kids with a nonverbal over 80, but if the
conceptual is 70ish that would suggest the verbal is quite a
bit below 70.>>Ah.>>Does that make sense?>>Yep. I would expect they wouldn’t
have the language score they would need to get it. There would be something to
disqualify them essentially.>>So the verbal/nonverbal is a
or condition or�– [ Inaudible ]
>>The verbal or nonverbal is an or condition. The conceptual is a must. It has to be above 70.>>I see.>>Mm-hmm.>>I’m not familiar with this
preschool language scale. I’m very familiar with the�
PPVT and — [ Inaudible ]
How is this different?>>The PPVT is more like
vocabulary-based. Can they identify words and say
the words.>>So it’s receptive and
expressive.>>Yep. So this is more — this is
heavier language-based. The tasks are more complex than
just point and identify.>>Okay. The PPVT is highly correlated
with IQ. So a lot of times they use it as
an IQ proxy.>>Mm-hmm. Certainly would be faster than
the differential ability scales.>>The only challenge with the
PPVT in this population is they can have inflated PPVT scores
compared to what they can do in terms of language. They might have good vocab. Very good, like, communication. So if�PPVT — I’m sorry, the PLS
actually looks at communicative language, not just�–
>>Okay.>>Vocab.>>Yeah. That’s what I was trying to say
before.>>I’m not aware of this
measure. It’s really 0 to 6.>>I think. Something like that. Yeah.>>The other question I had
somewhat to Connie’s point in terms of ability to recruit, this
is something we have a problem with in this area. We are super struggling now to
get our sample in.>>Mm-hmm.>>Is there a reason you have a
cap of 6 years? Are you particularly interested
in the 3 to 6 range or would you consider extending up if
necessary?>>Mm-hmm. I thought about extending up if
necessary. Yeah. I think even to 7 especially. 8�– I mean, 8 is the end of the
early childhood period. I wouldn’t go beyond that.>>I’m thinking this would be
relevant for a lot of our 6, 7, 8-year-olds in the clinic that
we have. And I would just be�– I think
it would be hard to find 3-year-olds with ASD that are
high functioning like this because�they are not getting
— at that age.>>Oh, yeah. That’s a good point.>>Parents don’t realize yet
there is something unusual.>>Or if you try it with
siblings who are older who are diagnosed.>>Yes.>>You may get some of the
Undiagnosed people.>>5 to 6 is not so bad. But this is very in the
forefront of my head because we have been doing
a huge push trying to recruit kids.>>Yeah.>>And just I�– you know.>>It’s just hard.>>Yeah.>>Kristin?>>Yes.>>There was a�– last summer at
the Institute for Autism Research in Buffalo.>>Mm-hmm.>>They had — one of the post
docs ran a downward extension of the max program.>>Okay.>>The max program was really
designed for 7 to 12 years old. But the post doc did a downward
extension. I’m not sure how low it went. I know it went into the
preschool age range. That would be — the anchor
for it in terms of skills would be a set of skills
relevant to preschoolers on the spectrum from the
skill streaming curriculum.>>Mm-hmm.>>Some of them, it’s not
specific to emotional regulation, but to the extent that emotional
regulation skills all within something that’s needed for
social skills, it would be a part of what they did.>>Yeah.>>I’m mentioning it because I
could put you in contact with Kristen MacDonald who was the
post doc that ran it, you know, if it would be helpful
in any I way in terms of what her experience was like doing that.>>Yeah. That would be great.>>It may give�– to the extent
it overlaps at all with what you’re doing it may�– you know,
she may have had some experience last summer that might be
helpful in terms of saying what seemed to work, what didn’t work
so well, that kind of thing.>>Yeah, that would be
excellent.>>The screening procedures
sound very similar, too. They used the PLS. I think they used the DAS-II. They might have used that or
they might have used the WIPSY. I’m not sure. In any case it could be another
person doing some work in the same age range with high
functioning kids that you could talk to and bounce things off
of.>>Yeah. That would be great.>>Okay.>>Thanks.>>Exciting project.>>Thanks.>>Yeah. Thanks for all of your thoughts. It’s so helpful to get this type
of feedback now so I can make the changes instead of three
months down the road and realize I could have done things better.>>Can I ask a completely
unrelated clinical question about the DAS?>>I know it goes down to two
and a half. We are thinking about different
assessments for our clinic. I know this one is used a lot in
the ASD literature. My question is can kids that
can’t do the WIPSY do the DAS? Or is it one of those things
like if they are not able to do the WIPSY you are looking at
a more developmental assessment like the Mullen and they are not
going to be able to get through the DAS?>>I am going to deflect to
Marty. I bet he knows the answer.>>It depends. There are definitely�– I mean,
one of the advantages with the DAS-II is that it offers a
nonverbal score that –>>Mm-hmm.
>>– you can use separately if the kids are not verbal. I would definitely say that
there are kids who could do the DAS-II that may not be able to do
the WIPSY.>>Okay.>>But still, I mean, there are
going to be kids that could bounce into the�– hit the floor
on the DAS-II �>>Okay.
>>– that are younger.>>Are there other developmental
assessments besides the Mullen which has not been updated in
eons?>>Right. I don’t know of an alternative
to the Mullen, unfortunately. I wish I could say I knew one,
but I don’t.>>Yeah.>>We did the Bailey on
internship. They’ll do the Bailey.>>I love the Bailey. Three and a half in terms of
age.>>That’s the difficulty. If you want an instrument that
you’re going to use repeatedly, you know, you’re going to end up
crossing instruments.>>Yep.>>The DAS-II, you know,
gives you a decent option that way. But, you know, just like the
issue with if you’re going to use the Bailey, the kid is going
to age out quickly and you’re using a different instrument at
that point. So finding one that works well,
you know, let’s say as a decent enough floor at 2 years old but
a decent enough ceiling to go to 6 or 7, that instrument doesn’t
necessarily exist.>>All right. Thank you very much. I was like thinking�– I used
the DAS years ago. I can’t remember it well enough
to be like this would solve our problems with kids that can’t
actually do some of these.>>Mm-hmm.>>Well, what about you, Marty? Thinking about renorming the
Mullen?>>There you go.>>It’s one of those things,
too, where the Mullen is interesting for what it is. But it is also�– I mean, it’s
very much�– you know, it’s very much a combination of language
and visual motor tasks that overlap with what you are
getting from the expressive and receptive PLS, too.>>Mm-hmm.>>Do you know what I mean? The constructs are only so
separate in this age range.>>Yep.>>Like the same issue with, you
know, cognitive ability versus achievement in preschoolers. I mean, it’s hard to make the
distinction at that age. So, no, I wasn’t thinking about
it. It is something that I think
should be done. I agree. So, yeah. I wish I had a better answer for
you in this situation.>>It was helpful though. Thank you.>>Yeah.>>At least realize I’m not
missing something major.>>Right.>>Thanks for participating,
Marty.>>All right. No problem. Sorry I couldn’t be there in
person.>>No worries.>>All right.>>All good. Have a good weekend.>>Bye.>>You, too.>>Oh, there’s Marty.>>Hello.

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